Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance

The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-lik...

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Veröffentlicht in:Antimicrobial agents and chemotherapy Jg. 59; H. 10; S. 5873
Hauptverfasser: Pitout, Johann D D, Nordmann, Patrice, Poirel, Laurent
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.10.2015
Schlagworte:
Anti-Bacterial Agents - pharmacology
Bacterial Proteins - genetics
Bacterial Proteins - metabolism
beta-Lactam Resistance - genetics
beta-Lactamases - genetics
beta-Lactamases - metabolism
Carbapenems - pharmacology
Clone Cells
Conjugation, Genetic
Cross Infection - drug therapy
Cross Infection - epidemiology
Cross Infection - microbiology
DNA Transposable Elements
Gene Expression Regulation, Bacterial
Humans
Klebsiella Infections - drug therapy
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - enzymology
Klebsiella pneumoniae - genetics
Klebsiella pneumoniae - pathogenicity
Plasmids - chemistry
Plasmids - metabolism
Porins - deficiency
Porins - genetics
Recombination, Genetic
ISSN:1098-6596, 1098-6596
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Zusammenfassung:The management of infections due to Klebsiella pneumoniae has been complicated by the emergence of antimicrobial resistance, especially to carbapenems. Resistance to carbapenems in K. pneumoniae involves multiple mechanisms, including the production of carbapenemases (e.g., KPC, NDM, VIM, OXA-48-like), as well as alterations in outer membrane permeability mediated by the loss of porins and the upregulation of efflux systems. The latter two mechanisms are often combined with high levels of other types of β-lactamases (e.g., AmpC). K. pneumoniae sequence type 258 (ST258) emerged during the early to mid-2000s as an important human pathogen and has spread extensively throughout the world. ST258 comprises two distinct lineages, namely, clades I and II, and it seems that ST258 is a hybrid clone that was created by a large recombination event between ST11 and ST442. Incompatibility group F plasmids with blaKPC have contributed significantly to the success of ST258. The optimal treatment of infections due to carbapenemase-producing K. pneumoniae remains unknown. Some newer agents show promise for treating infections due to KPC producers; however, effective options for the treatment of NDM producers remain elusive.
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ISSN:1098-6596
1098-6596
DOI:10.1128/AAC.01019-15